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Task force IDs PEIA complaints

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With the PEIA Task Force about midway through its series of 21 public hearings statewide, member Helen Matheny updated a legislative interim committee on PEIA on the major issues emerging from those proceedings.

"There are three main areas we've been hearing consistently," Matheny said of issues with accessibility, affordability and predictability.

She said accessibility is a major concern in border counties, where the closest medical specialists are often located across the state line and are not in the PEIA coverage network.

Delegate Ruth Rowan, R-Hampshire, agreed that is an issue, noting that constituents in her district have to drive to Morgantown for specialty care, even though there are specialists in nearby Winchester, Virginia.

"If you live in the central part of the state, you're probably getting the best [care] you can. Those in the border counties are not," she said.

Matheny said another common concern is affordability, with PEIA costs increasing beyond the ability of teachers and state employees to pay.

She said many have said they took jobs teaching or in state government "knowing they weren't going to get rich," but attracted by a benefits package that at the time included quality, low-cost health insurance.

Matheny said participants are calling for the state to develop a dedicated funding source - possibly through higher taxes on natural gas and/or soft drinks, restoring the sales tax on groceries, or imposing a tax on medical marijuana - so that PEIA will not have to annually increase premiums or cut benefits.

"The participants say they can't afford what they're paying now," she said.

She said that also goes for retirees, who in addition to seeking a freeze on PEIA premium increases, want the state to find a dedicated funding source to provide cost of living adjustments for their pensions.

Matheny said participants also want predictability in their PEIA coverage, with the most frequent complaint being the twice-yearly changes in the PEIA drug formulary.

She said people complained that when they go to the pharmacy to refill a prescription, often the drug is no longer on the formulary or has been changed to a higher copay.

Matheny said other issues raised at the hearings include objections to a proposal to set PEIA premiums based on total household income, and a short-lived program that would have imposed higher premiums and deductibles on insurees who fail to comply with PEIA wellness goals.

Matheny said participants want wellness and preventive medicine to be part of their PEIA coverage, but noted, "They would prefer incentives rather than penalties."

Gov. Jim Justice created the 29-member task force by executive order in February to comply with demands of striking teachers to find a "fix, not a freeze" for PEIA costs.

Mathany said task force subcommittees on Cost and Revenue and on Coverage and Plan are in organizational stages, since they can't fully proceed until the Public Outreach subcommittee, which she chairs, completes the public hearings. The final public hearing is scheduled for June 11 in Charleston.